The Northern Manhattan Healthy Heart Initiative (NMHHI) is in response to the NHLBI's interest in interventions that address multiple risk factors for people at high risk for cardiovascular disease (CVD) and utilizes the existing framework for community based participatory research in our NIH funded Center of Excellence on Health Disparities Research. We propose to examine the effectiveness of a Community Health Worker (CHW) intervention in CVD risk reduction among Caribbean Latinos. Although CHWs programs have exited in the US for over 4 decades, numerous recent reviews continue to identify the lack of rigorous evaluation data as the primary barrier limiting the dissemination of CHW programs. Our proposal addresses specific research priority needs of our community planning council. Our community partners participated in all aspects of the proposal including conception, jointly formulating the study design, and developing and writing major sections of the study intervention. The study design is a randomized controlled trial of 800 Latino patients aged 35-65 with hypertension, diabetes, or hypercholesterolemia being cared at 7 primary care sites. The study builds on a successful diabetes CHW program previously developed by our community partners and our medical center. The Specific Aim is to determine if a community based CHW intervention results in lowering of CVD risk factors at 18 months as measured by the Total Framingham Risk Score (FRS). Additional primary outcomes include blood pressure and LDL cholesterol. Secondary objectives will determine if the CHW intervention results in improvements in the following putative mechanisms that may influence the FRS: 1) Medication adherence; 2) Improvements in diet and exercise; and 3) Self efficacy, all measured using culturally validated instruments. At study conclusion we will also examine the cost effectiveness of our intervention. Our CHW intervention uses the Chronic Care Model as an overarching framework and builds on existing programmatic strengths at each CBO. Our two community partners will have a major role in this application including primary responsibly for subject recruitment, hiring and training the CHWs, delivering the CHW intervention, and collaborating on study finding dissemination. This is reflected in the budget, half of which is to the community partners. The dissemination activities to be undertaken by our team will prioritize developing mechanisms for the sustainability of the CHW intervention including discussions with our local Medicaid managed care plans which have ongoing interests in innovative cost-effective culturally appropriate health care delivery models such as CHWs. PUBLIC HEALTH RELEVANCE: Heart disease is the leading cause of death among Hispanics. Hispanics also have many risk factors for heart disease. Our study will determine if community health workers can reduce the risk of heart disease among Caribbean Latinos living in Northern Manhattan.